Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016

Abstract

Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; P trend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians.

Current Evidence on Abuse and Misuse of Gabapentinoids

“…According to a recent US study using data from the National Ambulatory Medical Care Survey, a four-fold increase in annual gabapentinoid-involved visits was observed from 2003 to 2016 [ 95 ]. Concomitant use with other drugs such as opioids (32.9%) or benzodiazepines (15.3%) was frequent in these cases.…”

Retrospective Cohort Study of Gabapentinoid Drug Use in Hospitalized Physical Medicine and Rehabilitation Clinic Patients

“…Gabapentinoid drugs (gabapentin and pregabalin) were initially developed as anti-epileptics, however, at the present time they are increasingly being prescribed for pain treatment. [3][4][5][6] Gabapentin has been approved by U.S. Food and Drug Administration (FDA) for the first time in 1993 for the treatment of epileptic attacks, and then in 2002 for the treatment of post-herpetic neuralgia. 3,5 In addition, they have been approved by European Medicines Agency (EMA) for neuropathic pain treatment.…”

“…In the studies carried out, the cases in which mostly gabapentinoids are effective or ineffective, the physicians prescribing them the most, the cases of abuse, the addiction status and the side effects have been assessed. 3,4,6 In a recent study, all outpatient visits in the U.S. between 2003 and 2016 have been scanned and it has been observed that the most common diagnosis among the first three diagnoses utilizing gabapentinoids were associated with musculoskeletal system (18.6%). Next come the diagnoses associated with nervous system (12.9%), mental disorders (8.2%) and diabetes mellitus (DM) (4.5%).…”

Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability

“…Gabapentinoids are often coadministered with other medications that also increase the risks associated with their use. An analysis of gabapentinoid‐involved US ambulatory care visits derived from the National Ambulatory Medical Care Survey identified frequent concurrent use with opioids (32.9%) or benzodiazepines (15.3%), 26 and an analysis in Scotland identified similar trends (opioids, 49.9%; benzodiazepines, 26.8%; or both, 17.1%) 27 . This is concerning because concomitant use of gabapentinoids with opioids has been demonstrated to increase the risk of emergency room visits and inpatient hospitalization 28 as well as death 29–32 .…”